Table 2.

Summary of treatments that target the microbiome for the treatment of NAFLD.

Treatment	Result
Prebiotics	• Modest reductions in serum aminotransferases, no histologic outcomes • Small cohorts studied
Probiotics	• Small reductions in serum aminotransferases, no histologic outcomes • No personalized treatment (i.e. no prior knowledge of microbiota composition)
Synbiotics	• No reduction in serum ALT levels
Antibiotics	• Short-term, limited studies
Fecal Microbial Transplantation	• In process, no study aimed at treating NAFLD has been published yet
JKB-121	• TLR4 receptor antagonist studied in phase II, double-blind, randomized, placebo-controlled trial × 24 weeks • Not superior to placebo in reducing MRI-PDFF and ALT in adults with NASH
Obeticholic acid	• FXR agonist studied in a double-blind, placebo-controlled, randomized, phase IIb trial × 72 weeks • Decreases NAS by ⩾2 without worsening of fibrosis with a relative risk reduction of 1.9 • Concerns regarding increase in LDL-C
NGM282	• Engineered variant of human FGF19 studied in a phase II, placebo-controlled, randomized controlled trial × 12 weeks • Leads to MRI-PDFF of <5% in up to 39% of patients with noncirrhotic NASH • Concerns regarding increase in LDL-C

ALT, alanine aminotransferase; FGF19, fibroblast growth factor 19; FXR, farnesoid X receptor; LDL-C, low-density lipoprotein cholesterol; MRI-PDFF, magnetic resonance imaging proton density fat fraction; NAFLD, nonalcoholic fatty liver disease; NAS, NAFLD activity score; TLR, Toll-like receptor.